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In eulogizing Ralph Klein, the former Alberta premier who died Friday at the age of 70, much was said about his debt-slaying prowess.
But too little was said about his attempts to reform healthcare. As a politician it was his greatest failure. But, in true Ralph Klein fashion, he did it with verve.
His reign produced one of the most iconic images in Canadian healthcare and spurred a vociferous debate about the role of the private sector in healthcare.
The lasting image is that of the Calgary General Hospital being demolished with a spectacular implosion. Critics used it as a symbol of Mr. Klein's destruction of healthcare but his budget-cutting and modernization was necessary and beneficial. In the end, he also oversaw an unprecedented boom in hospital construction, including the Calgary Children's Hospital.
Under his watch, Alberta also destroyed the traditional model of the centralized Ministry of Health by creating health regions – a wildly disruptive move that would eventually provide great results.
What Mr. Klein did with regionalization was give more power to regional health authorities but, beyond that, actually let health administrators run the health system.
He showed that the best thing politicians can do in healthcare is get out of the way. It was, unfortunately, a lesson lost on his successors, who have undone regionalization and micromanaged Alberta's health system back to profligate spending and mediocrity.
Mr. Klein's lasting legacy in healthcare, however, is his seeming disdain for the Canada Health Act. As premier, he commissioned the Mazankowski Report in 2002 and then championed the so-called "Third Way" in 2005, which challenged the underpinning of federal legislation, that hospital and physician services should be offered only under medicare.
In both initiatives, it was proposed that Albertans be allowed to purchase hospital and physician services and that a parallel private system should develop to meet that demand. Reaction was swift and bitter, particularly from the left. But even his natural allies, like Prime Minister Stephen Harper, distanced themselves from Mr. Klein's proposals, seeing them as political suicide.
"Every time you try to enact meaningful reform, the Friends of Medicare or the Raging Grannies kick up a hue and cry," he told the National Post years ago.
For Mr. Klein, meaningful reform meant allowing more private providers into the public health system and more private money into the funding side. His downfall was to propose that doctors be allowed to practise in both the public and in a parallel private system, an approach even most staunch Conservatives renounced.
But that one-step-too-far masks the fact that most of the other "Third Way" proposals were quite reasonable and, over time, have become quite mainstream. It's worth remembering what else the plan called for:
- Streamline regulation: Consolidate the 39 provincial laws and 100+ regulations that apply to healthcare;
- Develop a strategic plan for healthcare;
- Improve access with a wait-time guarantee;
- Get serious about wellness and injury prevention;
- Explore a pharmacare plan;
- Improve the quality in long-term care;
- Implement an electronic health record;
- Create primary care networks and intersciplinary healthcare teams;
- Invest in mental health.
- Develop a healthy kids strategy.
While Mr. Klein is, to this day, still portrayed as the evil purveyor of privatized healthcare, the reality is that, on that front, he did a lot more musing than implementing. Many of the other proposals, however, went ahead quietly.
The ultimate irony of all is that, under is watch, Alberta developed the strongest public healthcare system in the country, one that was the envy of every other province.
André Picard is The Globe and Mail's health columnist.